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Head Start ChildPlus Code Combinations: Level II and III FSW’s
Section I—Health Event Details
Event Name
Event Status
Blood Lead
Pass or Fail
Blood Pressure
Pass or Fail
Dental Exam
Pass or Fail
Growth Assessment
Pass or Fail
Health Assessment (Health
Completed
History, Nutrition History,
Tobacco Memo and
Preventative Dental
Pamphlet)
Hearing
Pass or Fail
Hemoglobin/Hematocrit
Pass or Fail
Lead Risk Assessment
Pass or Fail
Physical
Completed
TB Risk Assessment
Pass or Fail
Vision
Pass or Fail
NOTE: The following status options are discretionary codes:

The “PARENT REFUSED” status code is reserved for:
o events that a parent has truly refused to complete (Documentation must be in file)
o closing out health events that remained incomplete for a child who dropped from the program
(Documentation of your attempts to obtain the health event must be in file)

The “NOT REQUIRED” status code is reserved for children who have an IEP or IFSP and/or has a medical
diagnosis that would prevent the screen from occurring. (i.e. the “NOT REQUIRED” code would be assigned
for a hearing screen for a deaf child.)

The “DOCTOR REFUSED” status code is reserved for:
o health events that we have obtained written documentation for from a medical provider that he/she
is refusing to complete the screen (Documentation must be in the file)
Revised 4/2017
Section II—Actions Associated with a Health Event
Event Type
Blood Lead
(Lead Test)
Action Type
Status
Codes
Provider
Code
Funding
Code
Referral
Written
Head Start
Head Start
Use when a child has a blood lead
level above 5.0.
Follow-up
Case
Management
Head Start
Head Start
Use when you discuss the failed
dental exam with the parent.
Referral
Written
Head Start
Head Start
Use when you completed an
Internal Request for Follow-up
Services due to a failed dental
that the parent has failed to
follow-up on or that the parent
requires assistance in obtaining
treatment.
Treatment
In Treatment
Process
Doctor/Dentist
Insurance
Type: State
Insurance
(Medi-Cal)
or Private
Use when you have
documentation that the child has
received treatment but requires
more or when treatment is
identified on a follow-up dental
exam. NOTE: If child did receive
treatment at this appointment,
check the “treatment received”
box.
Treatment
Treatment
Completed
Doctor/Dentist
Insurance
Type: State
Insurance
(Medi-Cal)
or Private
Use when you have
documentation that the child has
completed all required treatment.
Check the “treatment received”
box.
Evaluation
Consultation
Observation
Dental
Consultant
Head Start
Use when a child has a
preexisting dental exam on file but
sees our dental consultant in the
midst of follow-up. NOTE: DO
NOT CHECK THE “TREATMENT
RECEIVED” BOX.
Follow-up
Parent
Refused
Head Start
Head Start
Use when a parent refuses to
accept a referral to discuss the
child’s failed growth assessment.
Evaluation
Evaluation
Completed,
No tx needed
Other
Free
Child is overweight but receives
WIC services.
Referral
Written
Head Start
Head Start
Use when you completed an
Internal Request for Follow-up
Services due to an underweight or
obese growth assessment for a
parent who wishes to have a
consultation with our RD.
Dental Exam
Growth
Assessment
Circumstance
Revised 4/2017
Follow-up
Screening
Complete,
Passed
Head Start
Head Start
Use when you rescreen a child
and the child passes the screen.
Follow-up
Failed 1st
Rescreen
Head Start
Head Start
Use when you rescreen a child
and the child fails the screen.
NOTE: This will need to be
followed up by the Referral
sequence.
Referral
Written
Head Start
Head Start
Use when you completed an
Internal Request for Follow-up
Services due to a failed rescreen.
Follow-up
Parent
Refused
Head Start
Head Start
Use when a parent refuses to
accept a referral to discuss the
child’s failed hemoglobin.
Evaluation
Evaluation
Completed,
no tx needed
Other
Free
Use when a child fails a
hemoglobin/hematocrit (10-11.5
and 30-34%) but receives WIC
services.
Evaluation
Evaluation
Completed,
no tx needed
Doctor/Dentist
Insurance
Type: State
Insurance
(Medi-Cal)
or Private
Use when a child fails a
hemoglobin/hematocrit (10-11.5
and 30-34%) but the doctor has
deemed as “healthy”
Referral
Written
Head Start
Head Start
Use when you completed an
Internal Request for Follow-up
Services due to a hemoglobin
below 10.0 or a hematocrit below
30% for a parent who wishes to
have a consultation with our RD.
Follow-up
Rec’d
Results, no
further action
needed
Head Start
Head Start
Use when a child fails a Lead Risk
Assessment but the parent has
provided you with a blood lead
test at enrollment.
Referral
Written
Head Start
Head Start
Use when a child fails a Lead Risk
Assessment and the parent has
not provided you with a blood lead
test at enrollment.
Follow-up
Rec’d
Results, no
further action
needed
Head Start
Head Start
Use when a child fails a TB Risk
Assessment but the parent has
provided you with a TB Skin at
enrollment.
Referral
Written
Head Start
Head Start
Use when a child fails a TB Risk
Assessment and the parent has
not provided you with a TB Skin
test at enrollment.
Hearing
Hemoglobin/
Hematocrit
Lead Risk
Assessment
TB Risk
Assessment
Revised 4/2017
Follow-up
Screening
Complete,
passed
Head Start
Head Start
Use when you rescreen a child
and the child passes the screen.
Follow-up
Failed 1st
Rescreen
Head Start
Head Start
Use when you rescreen a child
and the child fails the screen.
NOTE: This will need to be
followed up by the Referral
sequence (see below)
Referral
Written
Head Start
Head Start
Use when you completed an
Internal Request for Follow-up
Services due to a failed rescreen.
Vision

NOTE: There should be no deviation from the above prescribed list of code combinations. If you require additional
assistance, please contact a Health/Nutrition Specialist immediately.

NOTE 2: All mentions of “Internal Requests for Follow-up Services” will be sent to SOP Health/Nutrition Services.

NOTE 3: All follow-up on failed health events must also be documented in each child’s file, under the family contact
section.
Revised 4/2017